Multidimensional Analysis of Risk Factors for the Severity and Mortality of Patients with COVID-19 and Diabetes

Abstract

Introduction: Diabetes is one of the most common comorbidities of COVID-19. We aimed to conduct a multidimensional analysis of risk factors associated with the severity and mortality of patients with COVID-19 and diabetes.

Methods: In this retrospective study involving 1443 patients with COVID-19, we analyzed the clinical and laboratory characteristics and risk factors associated with disease severity in patients with COVID-19 with and without diabetes. Binary logistic regression analyses were performed to identify the risk factors associated with mortality in patients with COVID-19 and diabetes. The 84-day survival duration for critical patients with COVID-19 and diabetes who had different levels of leukocytes and neutrophils, or treated with immunoglobulin or not, was conducted using Kaplan-Meier survival curves.

Results: Of the 1443 patients with COVID-19, 256 (17.7%) had diabetes, had a median age of 66.0 [IQR 58.0-73.8] years, and were more likely to develop severe (41.8% vs. 35.6%) and critical disease (34.0% vs. 14.9%), followed by higher mortality (21.1% vs. 7.0%), than those without diabetes. Higher levels of leukocytes (> 5.37 × 10⁹/L), older age, and comorbid cerebrovascular disease and chronic renal disease independently contributed to in-hospital death of patients with COVID-19 and diabetes. Leukocytes > 5.37 × 10⁹/L and the application of immunoglobulin were associated with shorter survival duration and lower mortality, respectively, in critical patients with COVID-19 and diabetes.

Conclusions: More attention should be paid to patients with COVID-19 and diabetes, especially when they have high leukocyte counts (> 5.37 × 10⁹/L). Timely and adequate intravenous immunoglobulin (IVIG) use may reduce the mortality of critical patients with COVID-19 and diabetes.

Keywords: Diabetes mellitus; Immunoglobulin; Prognosis; SARS-CoV-2.

Fig. 1

a, b ROC analysis of leukocytes and neutrophils for the risk of death in the critical group with diabetes (n = 87). c, d Kaplan–Meier survival curve for critically ill patients with COVID-19 and diabetes with different counts of leukocytes (P = 0.0448) and neutrophils (P = 0.1426), and who use immunoglobulin or not (e)